Überinfusion von Verbrennungsopfern: häufig und schädlich [Over infusion in burn victims: frequent and injurious]

Major burns are characterized by an initial capillary leak, which requires fluid resuscitation for hemodynamic stabilization. While under resuscitation was the major cause of death until the 1980s, over resuscitation has become an important source of complications, including abdominal compartment syndrome, escharosis, impaired gas exchange with prolonged mechanical ventilation and hospital stay. Fluid over infusion started in the 1990s with an increasing proportion of the fluid delivered within the first 24 h being well above the 4 ml/kg/% burn surface area (BSA) according to the Parkland formula. The first alerts were published in the form of case reports of increased mortality due to abdominal compartment syndrome and respiratory failure. This paper analyses the causes of this fluid over infusion and the ways to prevent it, which include rationing prehospital fluid delivery, avoiding early administration of colloids and prevention by permissive hypovolemia.

Effects of repeated slash removal in thinned stands on soil chemistry and understorey vegetation

Abstract

Do standard burn mortality formulae work on a population of severely burned children and adults?

Accurate prediction of mortality following burns is useful as an audit tool, and for providing treatment plan and resource allocation criteria. Common burn formulae (Ryan Score, Abbreviated Burn Severity Index (ABSI), classic and revised Baux) have not been compared with the standard Acute Physiology and Chronic Health Evaluation II (APACHEII) or re-validated in a severely (≥20% total burn surface area) burned population. Furthermore, the revised Baux (R-Baux) has been externally validated thoroughly only once and the pediatric Baux (P-Baux) has yet to be. Using 522 severely burned patients, we show that burn formulae (ABSI, Baux, revised Baux) outperform APACHEII among adults (AUROC increase p<0.001 adults; p>0.5 children). The Ryan Score performs well especially among the most at-risk populations (estimated mortality [90% CI] original versus current study: 33% [26-41%] versus 30.18% [24.25-36.86%] for Ryan Score 2; 87% [78-93%] versus 66.48% [51.31-78.87%] for Ryan Score 3). The R-Baux shows accurate discrimination (AUROC 0.908 [0.869-0.947]) and is well-calibrated. However, the ABSI and P-Baux, although showing high measures of discrimination (AUROC 0.826 [0.737-0.916] and 0.848 [0.758-0.938]) in children), exceedingly overestimates mortality, indicating poor calibration. We highlight challenges in designing and employing scores that are applicable to a wide range of populations.

Nutritional, immunological and microbiological profiles of burn patients

A burn is a lesion on an organic tissue resultant from direct or indirect action of heat on the organism. The present study aimed to evaluate the nutritional, immunological and microbiological status of burn patients at the Bauru State Hospital, São Paulo state, Brazil, in 2007. Eight patients, aged more than 18 years and injured up to 24 hours, were evaluated at the moment of hospitalization and seven days later. All victims were males with a mean age of 38 years. on average, 17.5% of their body surfaces were burned and 50% of the patients were eutrophic. There were significant alterations in levels of erythrocytes, hemoglobin, hematocrit, total protein and albumin due to increased endothelial permeability, direct destruction of proteins in the heat-affected area and blood loss from lesions or debridement. At a second moment, cytokines IL-6 and TNF-alpha had augmented significantly, with IL-6 presenting elevated levels in relation to controls at the first moment. Microbiological analysis showed that 100% of the samples collected at hospital admission were negative and after one week Staphylococcus aureus was found in all cultures. Therefore, a burn patient may be considered immunosuppressed and these results indicate significant nutritional, immunological and microbiological alterations that can interfere in his recovery.

Understorey fire propagation and tree mortality on adjacent areas to an Amazonian deforestation fire

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Production grinding burn detection using acoustic emission and electric power signals

This work uses a monitoring system based on a PC platform, where the acoustic emission and electric power signals generated during the grinding process are used to investigate superficial burning occurrence in a surface grinding operation using two types of steel, three grinding conditions and an Al203 vitrified grinding wheel. Acoustic emission signals on the workpiece and grinding power were measured during a surface plunge operation until the grinding burn happened. From the results the standard deviation of the acoustic emission signal and the maximum electric power were calculated for each grinding pass. The proposed DPO parameter is the product between the power level and acoustic emission standard deviation. The results show that both signals can be used for burning detection, and the parameter DPO is the best indicator for the burning studied in this work. This can be explained by the high dispersion of the acoustic emission RMS level associated to the high power consumption when the grinding wheel lose its sharpness.

Ketorolac eye drops reduce inflammation and delay re-epithelization in response to corneal alkali burn in rabbits, without affecting iNOS or MMP-9

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

AN EPIDEMIOLOGIC DESCRIPTION AND ANALYSIS OF LOST WORKDAY OCCUPATIONAL BURN INJURIES

Background research consisted of a hospital case series of all adult burn patients (n = 162) admitted to John Sealy Hospital's burn unit from January 1978 to June 1979. Comparisons between occupationally and nonoccupationally burned adults demonstrated that occupationally burned adults were significantly more likely to have been active in the burn injury event and to have changed jobs during the prior year. They were significantly less likely to have physical or mental problems which contributed to sustaining the burn injury. Comparisons between occupational and nonoccupational burn injury events concluded that occupational burn injury events were significantly more likely to involve multiple sources of energy, sparks as the source of ignition and gases as the source of combustion. Other salient characteristics of occupational burn injuries indicated that subsequent research should focus upon lost workday occupational burns and other injuries sustained by blue-collar petrochemical workers employed in Galveston County, Texas.^ Subsequent research consisted of a historical cohort study of occupational injuries sustained in 1979 by a cohort of blue-collar petrochemical workers (n = 1771) who belonged to O.C.A.W. Local 4-449 in Texas City, Texas. Specific cohort injury rates included 15.08 occupational injuries per 100 person work-years, 11.98 lost workday occupational injuries per 100 person work-years, and 1.64 lost workday occupational burn injuries per 100 person work-years. Salient results from this study indicate that burn injuries are a very important type (in terms of both frequency and severity) of occupational injury sustained by blue-collar petrochemical workers, pipefitters are at greatest risk of lost workday injuries and lost workday burn injuries, company-specific experiences are comparable for lost workday occupational injuries, differences among company-specific nonlost workday occupational injury experiences may not be "safety-related", and minimal job-specific experience may not place employees at greater risk of lost workday burn injuries.^

Presentation and discussion of the UAM/exercise I-1b: "Pin-Cell Burn-Up Benchmark" with the hybrid method

The aim of this work is to present the Exercise I-1b “pin-cell burn-up benchmark” proposed in the framework of OECD LWR UAM. Its objective is to address the uncertainty due to the basic nuclear data as well as the impact of processing the nuclear and covariance data in a pin-cell depletion calculation. Four different sensitivity/uncertainty propagation methodologies participate in this benchmark (GRS, NRG, UPM, and SNU&KAERI). The paper describes the main features of the UPM model (hybrid method) compared with other methodologies. The requested output provided by UPM is presented, and it is discussed regarding the results of other methodologies.

Validation of the burn-up code EVOLCODE 2.0 with PWR experimental data and with a Sensitivity/Uncertainty analysis

A validation of the burn-up simulation system EVOLCODE 2.0 is presented here, involving the experimental measurement of U and Pu isotopes and some fission fragments production ratios after a burn-up of around 30 GWd/tU in a Pressurized Light Water Reactor (PWR). This work provides an in-depth analysis of the validation results, including the possible sources of the uncertainties. An uncertainty analysis based on the sensitivity methodology has been also performed, providing the uncertainties in the isotopic content propagated from the cross sections uncertainties. An improvement of the classical Sensitivity/ Uncertainty (S/U) model has been developed to take into account the implicit dependence of the neutron flux normalization, that is, the effect of the constant power of the reactor. The improved S/U methodology, neglected in this kind of studies, has proven to be an important contribution to the explanation of some simulation-experiment discrepancies for which, in general, the cross section uncertainties are, for the most relevant actinides, an important contributor to the simulation uncertainties, of the same order of magnitude and sometimes even larger than the experimental uncertainties and the experiment- simulation differences. Additionally, some hints for the improvement of the JEFF3.1.1 fission yield library and for the correction of some errata in the experimental data are presented.

Living thoughts in words that burn, from poet, sage and humorist.

Mode of access: Internet.

Guidance on setting permit conditions and reporting trial burn results : handbook.

Library has volume II only.

O! She doth teach the torches to burn bright: How JULIET can help authors and repository advocates.

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